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Understanding how physician cognitive biases affect the treatment of older adults with dementia and other vulnerable populations

了解医生认知偏差如何影响患有痴呆症的老年人和其他弱势群体的治疗

基本信息

批准号：
9768138
负责人：
Dan Ly
金额：
$ 7.41万
依托单位：
HARVARD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-07 至 2020-08-06
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9768138
关键词：
Accident and Emergency department Advisory Committees Advocate Affect Age Alzheimer&apos s disease related dementia Attention Behavior Boston Caring Clinical Clinical Data Cognitive Communication Data Databases Decision Making Dementia Development Diagnosis Diagnostic Doctor of Philosophy Economics Educational process of instructing Elderly Electronic Health Record Evaluation Event Experimental Designs Fellowship Future Geriatrics Gerontology Goals Health Health Policy Healthcare Systems Heart Rate Informatics Inpatients Intervention Lead Life Medical Records Memory Loss Mentors Methodology Methods Mind Minority Modeling Patient Care Patients Physicians Population Pulmonary Embolism Quality of Care Race Reporting Research Research Personnel Risk Role Sampling Shortness of Breath Specialist Subgroup Testing Time Training Unconscious State Universities Veterans Vulnerable Populations Work aging population base clinical decision-making clinical risk design ethnic minority population experience health care disparity heuristics high risk improved interest older patient premature primary outcome racial minority skills statistics support tools

项目摘要

Project Summary Dan P. Ly, MD, MPP, is an inpatient teaching attending physician in the Veterans Affairs (VA) Boston Healthcare System and a PhD candidate in health policy (economics track) at Harvard University whose long- term interest is in improving the quality of care for vulnerable populations. This postdoctoral fellowship will help Dr. Ly develop into an independent investigator with expertise in physician decision-making. Dr. Ly's extensive programming experience with large databases and the substantial formal training he has received have prepared him to perform the proposed research. This proposal, on how cognitive biases among physicians may be exacerbated when caring for older adults with Alzheimer's Disease and Related Dementias (ADRD) and for minority patients, builds on Dr. Ly's prior work on health care disparities by testing for a mechanism for such disparities. The training plan will build upon prior training through three goals: 1) gain guided experience with the care of older adults from specialists in dementia and geriatrics; 2) develop expertise in helping doctors make better decisions; and 3) acquire skills in methodology (e.g., qualitative and experimental methods) complementary to Dr. Ly's training in large database analysis. Dr. Ly will be mentored by Dr. David Cutler, a nationally-renowned health economist who is an eager and experienced mentor. His co-mentor is Dr. Anupam Jena, a physician and health economist with physician behavior expertise. Dr. Ly has assembled an advisory committee with expertises in gerontology, decision-making, statistics, management, and informatics. Quality of care is known to be suboptimal, particularly for older adults. As the population ages, it is important to identify barriers to delivering high-quality care to older adults. One set of barriers may be physician cognitive biases that may occur more often when caring for such patients, especially patients with conditions like ADRD that may make communication difficult. Some cognitive biases may also worsen when caring for racial and ethnic minority patients. Little is known about consequences of cognitive biases on a national scale for these vulnerable populations because the factors physicians weigh are often not in the claims data commonly used. Dr. Ly will use rich, national electronic health record data from the VA and focus on a common scenario: assessing patients with shortness of breath for the risk of pulmonary embolism (PE). His project has three aims. First, he will examine whether physicians pay attention to objective clinical factors validated to correlate with PE risk and whether they also focus on arguably extraneous factors, such as diagnoses of recent patients seen (Aim 1). Second, he will determine whether physician attention on these objective factors is significantly lower for patients with ADRD (Aim 2). Third, he will examine whether this attention is also significantly lower for minority patients (Aim 3). This research may help explain deficiencies in quality of care for vulnerable populations and inform the design of future interventions to counter cognitive biases and improve care.

项目摘要 Dan P. Ly，医学博士，MPP，是波士顿退伍军人事务部（VA）的住院教学主治医师他是哈佛大学卫生政策（经济学方向）的博士候选人，长期利益在于提高对弱势群体的护理质量。这个博士后奖学金将有助于博士Ly发展成为一名独立的调查员，具有医生决策方面的专业知识。李医生的广泛性大型数据库编程经验和他所接受的大量正式培训，让他做好准备来进行研究。这个关于医生的认知偏见在照顾患有阿尔茨海默病和相关痴呆症（ADRD）的老年人时可能会加剧对于少数民族患者，建立在Ly博士先前关于医疗保健差异的工作基础上，通过测试一种机制，这样的差距。培训计划将通过三个目标建立在以前的培训基础上：1）获得指导经验与老年痴呆症和老年病专家的护理; 2）发展帮助医生的专业知识做出更好的决定; 3）掌握方法学方面的技能（例如，定性和实验方法）补充Ly博士在大型数据库分析方面的培训。Ly博士将由大卫卡特勒博士指导，全国知名的健康经济学家，他是一位热心而经验丰富的导师。他的共同导师是阿努潘博士耶拿是一位医生和健康经济学家，拥有医生行为方面的专业知识。李博士召集了一个顾问团该委员会拥有老年学、决策、统计、管理和信息学方面的专门知识。众所周知，护理质量不佳，特别是对老年人而言。随着人口老龄化，确定向老年人提供高质量护理的障碍。一组障碍可能是医生的认知在照顾这类患者时可能更经常发生的偏见，特别是患有ADRD等疾病的患者这可能会使沟通变得困难。在考虑种族和性别因素时，一些认知偏见也可能恶化。少数民族患者。对于这些认知偏差在全国范围内的后果知之甚少。弱势群体，因为医生权衡的因素往往不在常用的索赔数据中。博士Ly将使用来自VA的丰富的国家电子健康记录数据，并专注于一个常见的场景：评估呼吸急促患者的肺栓塞（PE）风险。他的项目有三个目标。首先，他将检查医生是否注意客观的临床因素，以及他们是否也关注可以争论的外部因素，例如最近患者的诊断见（目标1）。其次，他将确定医生对这些客观因素的关注是否显著 ADRD患者较低（目标2）。第三，他将研究这种关注是否也明显低于少数患者（目标3）。这项研究可能有助于解释弱势群体护理质量的缺陷。这将有助于提高人们的认识，并为未来干预措施的设计提供信息，以消除认知偏见并改善护理。